Patel Girish K, Knight Arthur G
Welsh Institute of Dermatology, Glamorgan House, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK.
Int Wound J. 2005 Sep;2(3):267-70. doi: 10.1111/j.1742-4801.2005.00121.x.
Subcutaneous low-molecular-weight heparin (LMWH) injections have a predictable dose-dependent anticoagulant effect and have therefore become popular for the prevention and management of thromboembolic diseases. It was initially hoped that use of the smaller molecule and better dose titration would reduce the incidence of side-effects associated with conventional heparin therapy. However, case reports such as this have demonstrated that LMWHs still have the capacity to cause heparin-induced thrombocytopaenia and heparin-induced thrombocytopaenia with thrombosis, as well as heparin necrosis. To our knowledge, this is the first-ever-reported case of heparin necrosis associated with tinazaparin. Heparin necrosis is characterised by widespread life-threatening cutaneous necrosis and systemic thrombosis, in which fatal progression of disease can only be halted by stopping heparin therapy. As heparin necrosis is an uncommon disorder, in this report we focus on the clinical clues that may help woundcare professionals consider and confirm the diagnosis.
皮下注射低分子量肝素（LMWH）具有可预测的剂量依赖性抗凝作用，因此在血栓栓塞性疾病的预防和管理中变得很受欢迎。最初人们希望使用较小的分子和更好的剂量滴定能够降低与传统肝素治疗相关的副作用发生率。然而，像这样的病例报告表明，低分子量肝素仍然有能力导致肝素诱导的血小板减少症以及伴有血栓形成的肝素诱导的血小板减少症，还有肝素坏死。据我们所知，这是首例报道的与替奈肝素相关的肝素坏死病例。肝素坏死的特征是广泛的危及生命的皮肤坏死和全身血栓形成，只有停止肝素治疗才能阻止疾病的致命进展。由于肝素坏死是一种罕见的疾病，在本报告中，我们重点关注可能有助于伤口护理专业人员考虑并确诊的临床线索。
